Between Sympathy, Fascination, and Powerlessness. The Experiences of Health Professionals During the Medical Monitoring of a Hunger Strike Among Undocumented Migrants.

In 2014, a group of undocumented migrants started a hunger strike in Brussels. The medical monitoring was mainly done by young, committed health professionals with no prior experience of medical monitoring of people on hunger strike. Following the hunger strike, two focus groups were organized to assess the experiences of the health professionals during the medical monitoring of the hunger strike. Their main motivation for assisting was wanting to help the people on hunger strike but they were also curious about the living conditions among undocumented migrants and the reasons behind starting the strike. They were puzzled by the paradox of hunger strikers putting their life at risk in order to get a better life and obtain a residence permit. They felt conflicted about their own role as a caregiver: they did not know how to deal with patients who did not comply with medical advice, they struggled to build a relationship of mutual trust and feared that they would end up being instrumentalized by the hunger strikers or their environment. Afterwards, some of the health professionals were deeply touched by the experience and there were reports of symptoms of secondary traumatic stress such as re-experiencing and avoidance. During the focus group's discussions, the respondents made suggestions on how to improve the medical monitoring in the event of any future hunger strikes.

The stability of blood eosinophils in stable chronic obstructive pulmonary disease: a retrospective study in Belgian primary care.

BACKGROUND: Blood eosinophil counts (BEC) were recently included in the 2019 Global Initiative for Obstructive Lung Disease (GOLD) guideline as an easily accessible theragnostic biomarker for Chronic Obstructive Pulmonary Disease (COPD). However, the stability of BEC remains insufficiently studied. METHODS: We conducted a retrospective study in six primary care practices in Belgium on data from Electronic Health Records of stable COPD patients, to characterise the stability of blood eosinophils over time. We report the percentage of patients with BEC persistently below or above the 2019 GOLD guideline thresholds (100 and 300 cells/µL). For each patient the mean, standard deviation (SD) and relative standard deviation (RSD) of the BEC were calculated to determine the intra-patient variability. RESULTS: Ninety-eight patients were included, yielding 1082 eosinophil measurements (median 8 measurements/patient), with BEC ranging between 0 and 1504 cells/µL. Four (4.1%) patients had BEC persistently below 100 cells/µL, 34 (34.7%) had measurements persistently above this threshold. Approximately half of the patients (51.0%) had BEC persistently below 300 cells/µL and 3 (3.1%) patients had counts persistently above this threshold. 28.6% of patients crossed both threshold values throughout the registration period. The mean BEC per patient ranged between 15 and 846 cells/µL with an intra-patient SD between 5 and 658 cells/µL. The mean intra-patient RSD was 0.46. There was a significant strong positive correlation (Pearson analyses) between the mean BEC and SD (r = 0.765; n = 98). Simple linear regression was used to further describe the influence of the mean eosinophil count on the SD (B = 0.500; 95%CI 0.415-0.586; n = 98; p < 0.001). CONCLUSION: BEC can be variable in individual COPD patients. Therefore, the use of a single measurement to guide therapeutic decisions remains debatable. Further prospective research remains necessary to validate the reproducibility of this biomarker.

Five Years Later: The Impact of a Hunger Strike on Undocumented Migrant Workers in Brussels.

Five years after a hunger strike of undocumented migrant workers, participants were interviewed to find out about the long term consequences and what the post-factum evaluation of their participation was. A longitudinal observational study was set up, interviewing 46 of the 100 ex-hunger strikers and combining quantitative and qualitative research. This grassroots study shows that one out of six did not derive any benefit from their participation. Half regretted their participation, especially the ones who lost again their legal permit, mentioning health consequences and the fact that their situation hadn't improved. Given the growing number of asylum seekers around the world who are being refused legal permits, hunger strikes will remain a pressing topic. Health professionals, confronted with this possible health and life threatening action, should be informed about the long term impact of voluntary fasting on body and mind of ex-participants.

The Role of Physicians During Hunger Strikes of Undocumented Migrant Workers in a Non-Custodial Setting.

Since the beginning of the 21st century, the living conditions of undocumented migrant workers in Belgium have deteriorated drastically. In Brussels, after various social actions, undocumented people began squatting and occupying public buildings to make their struggle visible to society. Desperate, some seized the possibility of a loophole in Belgian law that permits ill persons to have access to a temporary residence permit and started hunger striking. Confronted with consecutive strikes, medical teams of voluntary health professionals faced a big dilemma. A search of the medical literature yielded information about the overall and specific tasks of health professionals during hunger strikes in custodial and hospital settings, but no scientific guidelines were found to address the specific problems the team was confronted with. Information was collected about 15 hunger strikes over a period of seven years, involving the participation of 1,158 strikers. This article describes the medical, organizational, and ethical difficulties encountered in the follow-up of hunger strikes in non-custodial settings, including those associated with the establishment of a health-care structure, operation with very limited resources, and communication with the media and other health professionals.

A Training Game for Students Considering Family Medicine: an Educational Project Report.

The Groningen Institute Model for Management in Care Services aims to prepare medical students for their complex tasks as family physicians, based on the CanMEDS framework. Although initially developed for pharmacy students, the present paper reports on the eight-year experience with GIMMICS for family physician students at the Vrije Universiteit Brussel. The Groningen Institute Model for Management in Care Services is a training game that simulates real-life situations in a structured and supervised setting. It offers students the possibility to practice clinical, practical, and communicational skills. Students install and manage their group practices, hold consultations with simulated patients, participate in several assignments and collaborate with pharmacy students. Feedback sessions showed that the training game is well-received by the students. A self-assessment questionnaire comprised of 23 questions on significant aspects of the seven CanMEDS roles showed significantly higher scores at the end of the game for 17 questions (p<0.05, Wilcoxon signed-rank test ). GIMMICS is a valuable linking pin between the different learning methods in medical education and clinical practice, helping students to improve themselves in the CanMEDS roles. However, simulation-based medical education requires significant time and resource investment.

Health-related Factors Associated with Adherence to Breast Cancer Screening.

INTRODUCTION: In Belgium, an effective preventive program for breast cancer exists but as in many countries to few women participates in the screening. This study aims to describe the factors that affect the participation in the national breast cancer screening program. METHODS: The participants were aged between 50 and 69 years and were recruited during an exhibition at the Brussels Exhibition Centre. Medical history and health-related parameters of the participants were recorded. RESULTS: In total, 350 women aged between 50 and 69 years participated. After adjustment for age and region, 81.5% of the participants had a mammography during the past 2 years. The multivariate analysis confirms the association between not having had a mammography and (a) having an older age (odds ratio [OR]: 0.25-0.87), (b) having diabetes (OR: 0.08-0.80), (c) having a family history of coronary heart disease (OR: 0.16-0.80), (d) not following a cholesterol diet or treatment (OR: 0.10-0.91) and (e) having a higher body mass index (OR: 0.39-0.97). Having had a mammogram was associated with adherence to cervical smear screening (OR: 2.74-11.21). CONCLUSIONS: Most of these associations are most likely related to socioeconomic status. However, the relationship with diabetes offers opportunities to increase the participation in breast cancer screening programs because these patients have regular contacts with their family physicians.

Correlation between Body Mass Index and abdominal circumference in Belgian adults: a cross-sectional study.

INTRODUCTION: Traditionally, the body mass index (BMI) is used to describe anthropometric measurements and to assess weight-related health risks. However, the abdominal circumference (AC) might also be a valuable parameter to estimate this risk. This study aims to describe an association between the BMI and the AC. MATERIAL AND METHODS: Participants were recruited during the Brussels Food Fair in 2014. They completed a questionnaire with their medical history, and health related parameters such as blood pressure, weight, height and AC were measured. RESULTS: In total, 705 participants were analyzed. Men had a mean BMI of 27.3 kg/m2 and a mean AC of 98.7 cm. Women had a mean BMI of 26.0 kg/m2 and a mean AC of 88.2 cm. The Pearson's correlation coefficient between the BMI and the AC was 0.91 for men and 0.88 for women. There was a strong positive correlation between the BMI and the AC. In the identification of patients at high risk for weight-related diseases, the use of the AC identified more patients than the BMI. Especially more women were ranking in a higher risk class with the AC than with the BMI classification. Both the BMI as well as the AC identified most diseases with an increased relative risk. CONCLUSION: There is a strong correlation between the BMI and the AC. There are too few arguments to prefer the use of AC above the BMI to detect people at high risk for weight-related diseases.

New developments in inhaler devices within pharmaceutical companies: A systematic review of the impact on clinical outcomes and patient preferences.

BACKGROUND: Pharmaceutical companies offer an increasing number of inhaler devices, whether or not together with new substances, for maintenance treatment of patients with COPD or asthma. However, well-designed studies to support these developments are scarce. OBJECTIVES: The aim of this research was to evaluate how far new developments of inhaler devices are scientifically supported and translate into improvements of patient preferences and/or clinical outcomes. METHODS: A systematic literature review was performed to retrieve randomised controlled trials in patients with COPD or asthma that studied the in-company evolution of inhaler devices. Results were tabulated and discussed. RESULTS: A total of 30 studies were found comparing Respimat(®) vs. HandiHaler(®), Diskus(®)(Accuhaler(®)) vs. Diskhaler(®)(Rotadisk(®)) or pMDI, Ellipta(®) vs. Diskus(®)(Accuhaler(®)), Nexthaler(®) vs. pMDI, or Breezhaler(®) vs. Aerolizer(®). These studies show that developments of inhaler devices may improve patient satisfaction but do not lead to demonstrable improvements in clinical efficacy. Current changes of devices are most commonly parallelled by changes in administration frequency towards once daily treatment. The only well-documented effect was found for the Respimat(®) Soft Mist™ Inhaler, which realises a more than 3-fold lowering of the once-daily tiotropium dose through increased performance of the inhaler device. There are however, no data on clinical efficacy or safety comparing the two devices at the same dosage. CONCLUSIONS: Future developments of inhaler devices should all require well-designed studies to demonstrate patient benefit.

Health-related factors associated with the participation in cervical cancer screening.

BACKGROUND: The aim of this study was to describe the coverage for cervical cancer screening among the visitors of a food exhibition in Brussels, Belgium and to describe the factors that affect their participation in the screening programs. METHODS: The participants aged between 25 and 64 years were recruited during a food exhibition at the Brussels Exhibition Centre from 6 until 21 October 2012. Their participation to the cervical cancer screening was recorded as well as their medical history and health related parameters. RESULTS: After adjustment for age and region, 66% of the 408 participants have had a cervical cancer screening during the past three years. In univariate analysis, no participation in the cervical cancer screening was related to hypertension, high body mass index (BMI), and low self-reported health. There was no adherence to breast cancer screening. Age, systolic blood pressure, abdominal circumference and BMI of the participants who did not adhere to cervical cancer screening were significantly higher as compared to the participants who did adhere. A multivariate analysis confirmed the relationship between not adhering to the screening and older age (OR=0.56; 95% CI: 0.44, 0.73) and having a high body mass index (OR=0.63; 95% CI: 0.47, 0.85). Participation to the screening was related to having a tetanus vaccination (OR=1.67; 95% CI: 1.05, 2.63) and adhering to breast cancer screening (OR=3.9; 95% CI: 2.09, 6.84). CONCLUSIONS: Our study revealed an association between not having had a cervical smear in the last three years and not having had a mammography, older age, not having had a tetanus immunisation recently and having a higher BMI.

Relevance of chronic lyme disease to family medicine as a complex multidimensional chronic disease construct: a systematic review.

Lyme disease has become a global public health problem and a prototype of an emerging infection. Both treatment-refractory infection and symptoms that are related to Borrelia burgdorferi infection remain subject to controversy. Because of the absence of solid evidence on prevalence, causes, diagnostic criteria, tools and treatment options, the role of autoimmunity to residual or persisting antigens, and the role of a toxin or other bacterial-associated products that are responsible for the symptoms and signs, chronic Lyme disease (CLD) remains a relatively poorly understood chronic disease construct. The role and performance of family medicine in the detection, integrative treatment, and follow-up of CLD are not well studied either. The purpose of this paper is to describe insights into the complexity of CLD as a multidimensional chronic disease construct and its relevance to family medicine by means of a systematic literature review.

Diagnosis and treatment of participants of support groups for hypersexual disorder.

BACKGROUND: The aim of this study is to examine the extent to which members of support groups for hypersexual disorder meet the proposed criteria for hypersexual disorder of Kafka, how the diagnosis of hypersexual disorders is made and what treatments are currently given. METHODS: In this non-interventional research survey, members of support groups for hypersexual disorder received a questionnaire in which the criteria for hypersexual disorder according to Kafka were included as well as the way the disease was diagnosed and treated. RESULTS: The questionnaire was presented to 32 people but only 10 completed questionnaires were returned. Five of the ten respondents met the criteria of Kafka. For the other five respondents a hypersexual disorder was not confirmed but neither excluded. Only for three respondents the diagnosis was made by a professional healthcare worker. The treatment included - besides the support group in nine cases - also individual psychotherapy. Two respondents took a selective serotonin re-uptake inhibitor (SSRI), as recommended in the literature. CONCLUSIONS: The members of support groups for sex addiction were difficult to motivate for their participation. The way hypersexual disorders were diagnosed was far from optimal. Only two participants received the recommended medication.

Relevance of hypersexual disorder to family medicine and primary care as a complex multidimensional chronic disease construct.

Hypersexual disorder (HD) is not defined in a uniform way in the psychiatric literature. In the absence of solid evidence on prevalence, causes, empirically validated diagnostic criteria, instruments for diagnosis, consistent guidelines on treatment options, medical and psychosocial consequences, and type of caregivers that need to be involved, HD remains a controversial and relatively poorly understood chronic disease construct. The role of family medicine in the detection, treatment, and followup of HD is not well studied. The purpose of this paper is to describe the complexity of HD as a multidimensional chronic disease construct and its relevance to family medicine and primary care.

The use of family history in primary health care: a qualitative study.

The aim of this study is to describe how Belgian family physicians register and use the family history data of their patients in daily practice. Qualitative in-depth semistructured one-to-one interviews were conducted including 16 family physicians in Belgium. These interviews were recorded, transcribed, and analysed. Recurring themes were identified and compared with findings from the existing literature. All interviewed family physicians considered the family history as an important part of the medical records. Half of the surveyed physicians confirmed knowing the family history of at least 50% of their patients. The data on family history were mainly collected during the first consultations with the patient. The majority of physicians did not use a standardised questionnaire or form to collect and to record the family history. To estimate the impact of a family history, physicians seldom use official guidance or resources. Physicians perceived a lack of time and unreliable information provided by their patients as obstacles to collect and interpret the family history. Solutions that foster the use of family history data were identified at the level of the physician and also included the development of specific instruments integrated within the electronic medical record.

The GAy MEn Sex StudieS: erectile dysfunction among Belgian gay men.

AIM: To determine the prevalence of erectile dysfunction (ED) in a sample of the Belgian men who have sex with men (MSM) population, and to assess the relevance of major predictors such as age, relationship, and education. We investigated the use of phosphodiesterase type 5 (PDE5) inhibitors among Belgian MSM. METHODS: An internet-based survey on sexual behavior and sexual dysfunctions, called GAy MEn Sex StudieS (GAMESSS), was administered to MSM, aged 18 years or older, between the months of April and December 2008. The questionnaire used was a compilation of the Kinsey's Heterosexual-Homosexual Rating Scale, Erection Quality Scale (EQS), and the shortened version of the International Index of Erectile Function (IIEF-5). RESULTS: Of the 1752 participants, 45% indicated having some problems getting an erection. In this group of MSM, 71% reported mild ED; 22% mild to moderate ED; 6% moderate ED; and 2% severe ED. Independent predictors for the presence of ED were: age (odds ratio [OR] = 1.04, P < 0.0001), having a steady relationship (OR = 0.59, P < 0.0001), frequency of sex with their partner (OR = 1.22, P < 0.0001), versatile sex role (OR = 1.58, P = 0.016), passive sex role (OR = 3.12, P < 0.0001), problems with libido (OR = 1.15, P = 0.011), ejaculation problems (OR = 1.33, P < 0.0001), and anodyspareunia (OR = 0.87, P < 0.0001). Ten percent of the Belgian MSM used a PDE5 inhibitor (age 43 ± 11 years; mean ± standard deviation) and 83% of them were satisfied with the effects. "Street drugs" were used by 43% of MSM to improve ED. CONCLUSION: Forty-five percent of participating Belgian MSM reported some degree of ED and 10% used a PDE5 inhibitor to improve erections. Older MSM reported more ED. MSM, who were in a steady relationship or frequently had sex with a partner, reported less ED. MSM with ejaculation problems indicated having more ED.

The GAy MEn Sex StudieS: design of an online registration of sexual behaviour of men having sex with men and preliminary results (GAMESSS-study).

BACKGROUND: There has been limited investigation of the sexuality and sexual dysfunction in homosexuals by the sexual medicine community. The purpose of this article is to describe the methodology of the online GAy MEn Sex StudieS (GAMESSS) on the sexual behaviour and sexual dysfunctions of Belgian men who have sex with men (MSM). AIM: To describe the methodology of an online study that investigate sexual behaviour and sexual function and dysfunction in a sample of Belgian MSM. METHODS: An internet-based survey on sexual behaviour and sexual dysfunctions was administered to MSM between April and December 2008. The questionnaire was a compilation of the Kinsey Scale for Sexual Orientation, the Index of Premature Ejaculation (IPE), the Erection Quality Scale (EQS), the Female Sexual Function Index (FSFI), the Brief (Male) Sexual Function Inventory (BSFI) and the Gay Men Sexual Addiction Screening Test (G-SAST). The analytic sample comprised 1,830 Belgian men aged 18 years or older, who reported having sex with men. CONCLUSION: The use of an online questionnaire is a convenient way to gather information from a hidden population such as MSM. The anonymity of the participants is guaranteed. The collected data can be easily analyzed. With this online study, we aim to detect variables in sexual behaviour (SB) and sexual dysfunction (SD) that can help to improve care for MSM. Belgian MSM have a very active and varied sex life. They are rather promiscuous and do not always practice safe sex. This behaviour poses a high risk of spreading sexually transmitted diseases. Additional research in this MSM population is needed.

The Gay Men Sex Studies: prevalence of sexual dysfunctions in Belgian HIV(+) gay men.

The aim of this Internet-based survey was to investigate the prevalence and associated predictors of sexual dysfunctions in Belgian self-reported HIV-positive men who have sex with other men. Of the 72 participants, 56% had a mild-to-severe erectile dysfunction, and 15% reported a hypoactive sexual desire disorder. The prevalence of premature ejaculation and anodyspareunia was 18% for both. Independent predictors for erectile dysfunction were frequency of masturbation, frequency of sex with partner, use of erectile enhancement drugs, having a passive sex role, and not having a steady relationship. Independent predictors for hypoactive sexual desire disorder were frequency of masturbation and having a lower lifetime number of sexual partners. Independent predictors for premature ejaculation were not having a steady relationship, having a lower lifetime number of sexual partners, and a lower level of education. The only independent predictor for anodyspareunia was having an active sex role.

Comparison of knowledge and attitudes about vaccination between Belgian and immigrant adolescents.

Immigrant adolescents have different beliefs and attitudes about health and disease compared to Belgian adolescents. The aim of this study was to compare the knowledge of Belgian and immigrant adolescents concerning vaccination. In March 2009, adolescents between the ages of 14 and 17 years from three schools with a mixed Belgian and immigrant population in Antwerp completed a written questionnaire concerning vaccination. In total, 186 adolescents (88 immigrants and 98 Belgians) completed the questionnaire. Knowledge about vaccinations was slightly lower among immigrant adolescents (P<0.001). In both groups, the family physician and the school were the most important information sources for vaccination. Parents played a less important role among immigrant adolescents (50%) compared to Belgian adolescents (80%) (P=0.002). The physician, the school and the parents played key roles in the vaccination of both immigrants and Belgian adolescents.

The GAy MEn Sex StudieS: Anodyspareunia Among Belgian Gay Men.

INTRODUCTION: Anal intercourse is commonly associated with male homosexuality, but not all gay males engage in anal sex. Receptive anal intercourse can cause pain. Little is known about this sexual dysfunction. AIM: This study aims to determine the 4-week incidence of anodyspareunia (AD) in a sample of Belgian men who have sex with men (MSM) population and to assess the relevance of possible predictors such as age, relationship, and sexual behavior. METHODS: An internet-based survey on sexual behavior and sexual dysfunctions, called GAy MEn Sex StudieS, was administered to the MSM aged 18 years or older, between April and December 2008. A part of the questionnaire was focusing on anal eroticism. The participants, who self-reported being human immunodeficiency virus-positive or not having anal intercourse, were excluded. MAIN OUTCOME MEASURE: Female Sexual Function Index questions on pain domain adapted for anal intercourse. RESULTS: A total of 1,752 Belgian MSM completed the questionnaire. Of the 1,190 (68%) participants who reported engaging in receptive anal sex in the last 4 weeks, 59% indicated having some degree of anal pain during and after sexual intercourse. For 44%, the level of pain was acceptable. Mild AD was reported by 32%, 17% had mild to moderate AD, 4% had moderate AD, and 2% had severe AD. Independent predictors for the presence of AD were age, having a steady relationship, frequency of sex with their partner, number of sex partners, number of sex partners at the same time, and massaging the anal sphincter before anal sex. The prevalence and severity of AD among the MSM were lower among older participants, the MSM who more frequently had sex with their partner, and participants with a higher number of sex partners. Inadequate lubrication and lack of oral or digitoproctic stimulation prior to penetration were the most important factors predicting pain. Unsafe anal sex was performed by 28%. CONCLUSION: One-third of the participants reported not engaging in receptive nor penetrative anal sex. The 59% of participating Belgian MSM, who had anal receptive intercourse, reported some degree of AD. These findings highlight the need for more education about anal eroticism for MSM, and more research into AD is needed. Vansintejan J, Vandevoorde J, and Devroey D. The GAy MEn Sex StudieS: Anodyspareunia among Belgian gay men. Sex Med 2013;1:87-94.

Notification about influenza vaccination in Belgium: a descriptive study of how people want to be informed.

BACKGROUND: Influenza causes a substantial socioeconomic burden. In Belgium, only 54% of the target group receives an annual vaccination. Patient reminder/recall systems are effective in improving vaccination rates in primary care, but little is known about patients' preferences on notification of influenza vaccination. AIMS: To evaluate whether general practice patients wish to be notified of the possibility of receiving influenza immunisation, and how. METHODS: In January 2008, 750 questionnaires were handed out to all consecutive patients aged >18 years in three Belgian general practices. Main outcome measures were the percentage wanting to be notified, demographic and medical factors influencing the information needs of the patients and the specific way in which patients wanted to be notified. RESULTS: About 80% of respondents wanted to be notified of the possibility of influenza vaccination. Logistic regression analysis showed that those who had previously been vaccinated particularly wished to be notified, both in the total population (OR 4.45; 95% CI 2.87 to 6.90; p<0.0001) and in the subgroup of high-risk individuals (OR 9.05; 95% CI 4.47 to 18.33; p<0.0001). More than 85% of the participants wanted to be informed by their family physician, mostly during a consultation regardless of the reason for the encounter. The second most preferred option was a letter sent by the family physician enclosing a prescription. CONCLUSIONS: The majority of general practice patients want to be notified of the possibility of influenza vaccination. More than 85% of participants who wanted to be notified preferred to receive this information from their family physician, mostly by personal communication during a regular visit. However, since a large minority preferred to be addressed more proactively (letter, telephone call, e-mail), GPs should be encouraged to combine an opportunistic approach with a proactive one.